PROJECT SUMMARY In the United States, nearly 100,000 patients receive general anesthesia and sedation daily to safely undergo surgical and non-surgical procedures. A high proportion of these patients are older than 65 years of age. These older patients are at higher risk of post-operative delirium and cognitive dysfunction. Many of these older patients have dementia, including mild cognitive impairment or Alzheimer?s disease, further elevating their risk of POD and POCD. Anesthesiologists are familiar with how to adjust anesthetic management to account for changes in systemic physiology in older patients, e.g., blood pressure, heart rate, or respiration. Unfortunately, with existing technologies, anesthesiologists have no physiologically principled way to account for age-dependent changes in the brain?s response to anesthetic drugs. Today?s anesthetic brain monitors were developed in the 1990?s and do not account for recently-described age-dependent changes in brain activity during anesthesia. When these now outdated monitors are used, older patients are up to 10-times more likely to receive more anesthesia than necessary to maintain unconscious. In short, currently available anesthetic brain monitors are based on outdated science and technology and predispose older patients to unnecessarily high anesthetic exposures. The consequences for older patients and patients with dementia and/or Alzheimer?s disease can be significant, since increased anesthetic exposure is associated with increased incidence of delirium, post-operative cognitive dysfunction, and even mortality. PASCALL Systems, Inc. proposes to develop novel systems and personalized algorithms to monitor aging, dementia, and Alzheimer?s disease patients during general anesthesia and sedation.